Hip prostheses

ABSTRACT

Bipolar prostheses which include various structures and other techniques for optimizing material wear and mechanical strength properties. Such prostheses feature, for example, improved resistance to polyethylene wear while also reducing potential for dislocation of the femoral stem from the prosthesis. Such techniques and structures include varying wear resistance and mechanical strength treatment in various components of the prostheses or portions of those components as desired to improve, accentuate or optimize wear performance and dislocation reduction, locking ring structural features, structures for retaining locking rings in the bipolar prosthesis shell, and structures for limiting or reducing movement or rotation of locking rings and liners in bipolar prosthesis shells.

This application is a continuation-in-part of U.S. patent applicationSer. No. 10/243,502, now U.S. Pat. No. 6,986,792, filed Sep. 13, 2002,the entire contents of which are hereby incorporated by reference. Thisinvention relates to improved prostheses, including bipolar prostheses,suited to reduce polyethylene wear and potential of femoral/acetabulardislocation.

BACKGROUND

Bipolar prostheses generally provide two bearing surfaces between the(artificial) femoral head and the acetabulum. The first bearing surfaceis the typically smooth outer surface of the bipolar prosthesis shell,which may be formed of metal, ceramic material or as otherwise desired.A liner, conventionally formed of polyethylene material such as ultrahigh molecular weight polyethylene, may be adapted to fit tightly withinthe shell and provide an inner bearing surface which receives andcooperates with the femoral head in an articulating relationship totrack and accommodate the relative movement between the femur and theacetabulum.

This dual bearing surface design is often indicated for patients whoseacetabulae are relatively healthy and able to accommodate a prostheticproxy for the anatomical femoral head. Bipolar prostheses leverage thetheory that erosion and protrusion of the acetabulum will be less wherearticulating motion is absorbed by two bearing surfaces rather than one,i.e., relative movement between the shell outer surface and theacetabulum on the one hand and between the femoral stem head and theprosthesis liner on the other. The dual bearing surface thus distributesshear forces between the inner and outer bearings in order to spare theacetabular surface from wear and erosion. Additionally, acetabular wearis diminished through reduction of relative motion between theacetabular anatomy and the outer surface of the prosthesis because theinner bearing formed by the liner against the femoral stem head alsoabsorbs some of the motion. Moreover, the dual bearing surfacestypically provide greater range of motion than provided by eitherunipolar designs or conventional total hip arthoroplasty.

Even though bipolar prostheses are well beyond the first generation ofdesign and implementation, a number of issues remain. These include (1)the potential for dislocation of the femoral stem head relative to theshell/liner; and (2) polyethylene wear issues. (These two issues, asdiscussed more fully below, arise not only in the context of bipolarprostheses, but also in the context of acetabular components used intotal hip replacement surgery and other joint prostheses.)

The dislocation problem is exacerbated because dislocations oftenrequire surgical intervention to reestablish the prosthetic/hip joint.Accordingly, conventional bipolar designs and other hip prosthesisdesigns, often feature a snug fit in which the stem head is captured inthe liner. Such designs include a reduced diameter liner opening throughwhich the stem head is forced before installation of the shell/liner.Other designs feature retention rings or locking rings. However,overemphasis on dislocation prevention can reduce range of motionbetween the femoral stem and the shell/liner. Additionally, previousdesigns are limited by the extent to which the polyethylene can“stretch” to accommodate the stem head in a capture fit. That extent maybe insufficient for optimal dislocation prevention in non-locking ringdesigns. Some previous locking ring designs in bipolar prostheses haveaccommodated the issue by including a split in the annulus formed by thelocking ring so that the diameter of the locking ring may be expandedfor penetration of the stem head before installation of the prosthesis,and contracted again for installation in a manner that seeks toeffectively capture the stem head and thus prevent dislocation. Splitrings, however, present their own sets of issues, including potential toexpand and contract in diameter even after installed which can in turnintroduce polyethylene wear issues in addition to unacceptable“pistoning” of the stem head in the liner with potential polyethylenewear and stability complications.

Polyethylene wear has been recognized as an undesirable effect sometimescaused by articulating and non-articulating relative motion between apolyethylene surface and another surface such as, for instance, a metalsurface such as that of a bearing in a hip prosthesis. One reason thatpolyethylene wear is considered serious is that even a very small volumeof polyethylene debris actually includes a great number of polyethyleneparticles. For instance, one cubic millimeter of polyethylene weardebris can include up to ten trillion polyethylene particles. Theseparticles are believed to cause osteolysis when they escape into nearbybone and tissue. Such polyethylene wear can occur between surfaces whicharticulate relative to one another and surfaces which are intended notto articulate but only engage only in so-called “micromotion.”

Various approaches have been adopted in recent times in order to reducegeneration of polyethylene wear debris. These include careful andspecialized treatment of the polyethylene and the metal or othersurfaces which bear against the polyethylene. They also include measuresto enhance wear performance of the polyethylene such as irradiation andother processes employed to increase cross-linking or other materialproperties in the polyethylene. While cross-linking is advantageous toenhance polyethylene wear performance, it can also reduce mechanical andphysical properties of the polyethylene such as, for instance, yieldstrength, tensile strength, elongation and impact strength. Accordingly,while cross-linking measures are useful for reducing wear ofpolyethylene in bipolar prostheses, polyethylene liners and lockingrings formed of cross-linked polyethylene can suffer reduced ability tocapture and retain a femoral stem head in order to prevent dislocation.

SUMMARY OF THE INVENTION

Various embodiments of the present invention include various structuresand techniques for reducing polyethylene wear while at the same timeincreasing or at least not compromising ability of the shell/liner (orsimply a shell) in a hip prosthesis to reduce or prevent dislocation ofthe femoral stem head.

According to a first group of aspects according to certain embodimentsof the invention, material properties of portions of the shell/liner,shell, and/or locking ring located at predetermined locations on thosestructures can be altered such as by treating the material at thoselocations, in order to emphasize wear performance, while other locationscan be altered, treated differently, or not treated in order toemphasize other properties such as yield strength, tensile strength,elongation, and impact strength, among other properties. As a firstexample, in a total hip replacement acetabular component, portions of apolyethylene liner locked in a metallic shell could be treated toimprove cross-linking at locations deep in the liner that are expectedto absorb more compressive load from the femoral head, while portionswhich are located closer to the lip may omit such treatment so that theyfeature improved yield strength, tensile strength, elongationproperties, impact strength, and other mechanical properties that tendto aid the liner in retaining the femoral head in the liner. As a secondexample, in a bipolar prosthesis which includes a metallic shell with apolyethylene liner and a polyethylene retaining or locking ring, theliner may be formed of polyethylene which has been treated to improvecross linking or other properties that improve resistance topolyethylene wear, while the retaining or locking ring is not sotreated, treated to a lesser extent, or otherwise treated, in order tooptimize mechanical properties that help the locking ring retain thefemoral head and thus prevent dislocation of the head from the bipolarprosthesis. As a third example, portions of the metallic shell and/orfemoral stem head can be made or treated in order to improve wearperformance against polyethylene surfaces, including formation ortreatment to impart special finishes or compositions. Thus, bipolarprosthetic and other prosthetic components which feature polyethylenetreatment of the sort mentioned above or other location and/orproperty-sensitive polyethylene treatment as disclosed herein, can becombined with shells and/or heads on which special surfaces such as anoxidized zirconium surface has been imparted.

According to certain aspects of certain embodiments of the invention,structures and processes according to certain embodiments of the presentinvention exploit optimum performance properties of various types ofirradiated polyethylene materials. Because it has been generallyrecognized that cross-linked polyethylene which has been irradiatedaccording to conventional and other techniques exhibits improved wearperformance when placed in articulating and non-articulatingrelationships with metal and other surfaces, certain structures andprocesses according to certain embodiments of the present inventionoptimize cross linking of various regions of the liner which are in aposition to accept increased load from the femoral stem head. Theseportions may include some or all of the liner, including carefullyselected regions. On the other hand, the locking ring, or portions ofit, may be formed of non or reduced cross-linked polyethylene in orderto optimize properties such as yield strength, tensile strength,elongation and impact strength. The irradiation may occur according toany desired process, including irradiation of stock polyethylenematerial to whatever desired degree, irradiation of all or portion ofcomponents after they are formed into shape, combinations of thesetechniques, or as otherwise desired. Such optimized performance thusallows bipolar prostheses according to certain aspects of the presentinvention to minimize polyethylene wear while at the same time featuringacceptable or improved dislocation prevention properties. Accordingly,various embodiments of the invention relate to the use of cross-linkedpolyethylene (XLPE) in a bipolar hip implant. The XLPE may be used incombination with other types of polyethylene or any other suitablematerials. In certain embodiments, a minimum of two different types ofpolyethylene or other materials are used, one of which preferablyenhances the bearing performance and wear properties of the bipolarimplant. In other words, two different types of polyethylene (as opposedto treating the surface of one type of polyethylene with varyingcrosslinking) may be used to provide a multi-material liner.

According to another group of aspects of certain embodiments of thepresent invention, various mechanical and physical structures forbipolar prostheses in particular assist in improving wear performanceand resistance to dislocation.

As a first example of such mechanical or physical structures, certainbipolar prosthesis structures according to certain embodiments of thepresent invention feature non-split locking rings which are adapted tobe placed over the neck of a two-piece femoral stem before the head ismounted on the stem. The non-split locking ring thus features asubstantially smaller opening diameter than the largest diameter of thefemoral stem head so that it more effectively captures the head andreduces potential of dislocation. These aspects of the inventionaccordingly take advantage of modular hip stem designs, which allows thering to be assembled on the stem before the head is mounted, before thehead and locking ring are then assembled into the shell or shell/liner,in order to create a tighter locking ring constriction.

Such non-split locking rings can be adapted to be introduced andretained in the shell/liner combination or the shell using any retentioncomponent or approach, including without limitation an interference fit,a reverse biased lip, retention ring which is captured in a shell andcaptures liner lip or outer surfaces, or an indentation or groove formedin the outer surface of the locking ring which corresponds to anindentation or groove formed on the inner surface of the shell. A metalretainer such as a circular ring formed of appropriate spring metal canform a component in these structures.

Additionally, the locking ring, whether split or non-split, may featureirregularities such as a peripheral tab, protrusion or indentation whichcorresponds with and cooperates with structure on the inner surface ofthe shell in order to reduce or prevent rotation of the locking ringwithin the shell. Such reduced rotation reduces wear of polyethylene orother material from which the locking ring is formed.

In various structures according to certain embodiments of the presentinvention, which include a polyethylene liner within the shell, theliner outer surface can also include an irregularity such as a ridge oran indentation which cooperates with corresponding structure on theinner surface of the shell. These surfaces can accordingly preclude orreduce rotation of the liner in a shell in order to reduce wear of thematerials of which the shell and/or liner are formed.

It is accordingly an object of certain aspects of certain embodiments ofthe present invention to provide prostheses which enhance polyethylenewear performance properties while at the same time enhancing or notcompromising ability of the prosthesis to prevent or reduce dislocationof the femoral stem.

It is an additional object of certain aspects of certain embodiments ofthe present invention to provide hip prosthesis in which portions of abearing surface which cooperates with a femoral stem head accentuate,improve or optimize a first set of properties such as material wearperformance, and other portions of the surface accentuate, improve oroptimize a second set of properties such as yield strength, tensilestrength, elongation properties, and/or impact strength.

It is an additional object of certain aspects of certain embodiments ofthe present invention relating to hip prostheses which feature a shelland a liner, to provide a liner in which portions improve, accentuate oroptimize a first set of properties such as material wear performance,and other portions improve, accentuate or optimize a second set ofproperties such as yield strength, tensile strength, elongationproperties, and/or impact strength. The liner may be a multi-materialliner, e.g., formed from more than one type of material. In certainembodiments, the liner is formed from two different types of material,one of which is treated to enhance wear properties (e.g., cross-linkedpolyethylene and standard polyethylene). (For the purposes of thisapplication, treated polyethylene and standard polyethylene areconsidered two different types of material, and a liner made of bothtypes of material (or made of any other different types of materials)would be considered a multi-material liner.)

It is an additional object of certain aspects of certain embodiments ofthe present invention relating to hip prostheses which feature a shell,a liner and a locking ring, to provide a liner, and if desired a lockingring, in which portions improve, accentuate or optimize a first set ofproperties such as material wear performance, and other portionsimprove, accentuate or optimize a second set of properties such as yieldstrength, tensile strength, elongation properties, and/or impactstrength.

It is an additional object of certain aspects of certain embodiments ofthe present invention relating to hip prostheses which feature a shellwithout liner, to provide a shell in which portions improve, accentuateor optimize a first set of properties such as material wear performance,and other portions improve, accentuate or optimize a second set ofproperties such as yield strength, tensile strength, elongationproperties, and/or impact strength.

It is an additional object of certain aspects of certain embodiments ofthe present invention to provide bipolar hip prostheses which include aliner at least a portion of which is formed of polyethylene thatenhances wear performance, and a locking ring at least a portion ofwhich is formed of polyethylene which enhances mechanical performanceproperties such as yield strength, tensile strength, elongation andimpact strength.

It is an additional object of certain aspects of certain embodiments ofthe present invention to provide bipolar prostheses with a locking ringthat is designed to take advantage of two-piece femoral stem designswhich permit the locking ring to be assembled onto the femoral stembefore the head is mounted on the stem.

It is an additional object of certain aspects of certain embodiments ofthe present invention to provide bipolar prostheses which includemechanical structure to preclude or reduce relative motion between thelocking ring and the shell and/or between the liner and the shell inorder to reduce polyethylene wear.

It is an additional object of certain aspects of certain embodiments ofthe present invention to provide bipolar prostheses which employ alocking ring held in place by a retainer captured in a groove orcooperating with other structure in the outer surface of the lockingring in order to reduce relative motion between the locking ring and theshell and reduce pistoning and other undesired relative motion betweenthe femoral stem head and the shell or liner.

Other objects, features, and advantages of the invention and certainaspects and embodiments of it will become apparent with respect to theremainder of this document.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 shows a cross-sectional view of a preferred embodiment of aprosthesis according to certain aspects of the present invention.

FIG. 2 is a perspective view of the prosthesis of FIG. 1.

FIG. 3 is a perspective view of the liner of the prosthesis of FIG. 1.

FIG. 4 is a side elevational view of the liner of FIG. 3.

FIG. 5 is a plan view of the liner of FIG. 3.

FIG. 6 is a perspective view of the locking ring of FIG. 1.

FIG. 7 is a side elevational view of the locking ring of FIG. 6.

FIG. 8 is a plan view of the locking ring of FIG. 6.

FIG. 9 is a schematic view of another embodiment of a prosthesisaccording to certain aspects of the present invention.

DETAILED DESCRIPTION

a. Particular Bipolar Prosthetic Structures for Improving Material Wearand Dislocation Properties.

FIG. 1 is a cross-sectional view showing a preferred embodiment of abipolar prosthesis 10 according to certain aspects of the presentinvention. Prosthesis 10 generally includes a shell 12 which receives aliner 14 and a locking ring 16 which may be held in place by a retainer18. The prosthesis 10 is adapted to fit within and articulate, or fit inan articulating relationship with, the acetabulum. “Articulatingrelationship” means a physical relationship that allows relative motionor movement between two components of a prosthesis in a manner thatcorresponds to motion or movement of two body parts relative to eachother, such as bone structure on opposing sides of a joint such as anankle, knee, hip, wrist, elbow or shoulder. For instance, prosthesis 10and a femoral stem it accommodates are connected in an articulatingrelationship, while the liner fixed within the prosthesis may not beconnected in an articulating relationship with the shell. The stem andthe prosthesis “articulate” relative to each other.

Prosthesis 10 is adapted to receive head 20 which is mounted (such asusing a Morse taper) on neck 22 of a femoral stem 24. Femoral stem 24and these components may be any desired conventional stem components,formed of any desired materials.

Prosthesis 10 is thus adapted to be positioned in articulatingrelationship relative to a patient's acetabulum and relative to femoralstem 24. The outer surface 26 of shell 12 forms an outer bearing surfacewhich cooperates with the acetabulum tissue to form an outer bearing 28.The inner, bearing surface 30 of liner 14 and the inner, bearing surface32 of locking ring 16 cooperate with the femoral stem head 20 to form aninner bearing 34.

Shell 12 may be formed of any desirable material conventionally used forbipolar shells, including various metallic or ceramic materials. Outersurface 26 may be finished with a mirror surface, polished, or otherwisefinished for optimum articulation relative to the acetabulum. Outersurface 26 may form a portion of a sphere, an ovaloid structure orshaped as otherwise desired in order to optimize articulation while atthe same time reducing potential for migration and dislocation. It maybe equal to or form more or less than half of such a structure; forinstance, outer surface 26 may be hemispherical, more shallow thanhemispherical or deeper than hemispherical as desired.

Outer surface 26 of shell 12 may round or otherwise transition to aportal surface 36 of shell 12. Portal surface 36 as well as thetransition may assume any desired shape in order to accommodate theform, function and fit of prosthesis 10.

A shell cavity 38 is formed by a shell inner surface 40. As shown inFIG. 1, a first portion of shell cavity 38 may be dome shaped,hemispherical, or otherwise formed of a surface of rotation or asotherwise desired while a second portion, closer to portal surface 36,may be cylindrical or otherwise shaped as desired. Cavity 38 is formedto accept and receive liner 14 and locking ring 16. It may be shaped andsurfaced as desired in order to optimize the preferably non-articulatingrelationship between shell 12 and liner 14 on the one hand and shell 12and locking ring 16 on the other hand.

Liner 14, and ring 16, or desired portions of one or both of them, maybe formed of various types of polyethylene in a continuous ordiscontinuous fashion to improve, accentuate or optimize properties suchas wear performance. For instance, all of liner 14 may be formed ofhighly crossed-linked high-density polyethylene which has beenirradiated or otherwise treated, before or after being formed into theshape that corresponds to liner 14, while all of locking ring 16 mayomit such treatment in order to retain mechanical properties that helpresist femoral stem dislocation, such as yield strength, tensilestrength, elongation properties, and/or impact strength. Anycross-linking or wear resistance treatment of the materials from whichliner 14 or locking ring 16 are made can be employed. Treatment can alsooccur to enhance wear performance during or after the liner 14 and/orlocking ring 16 have been formed into shape. A combination of thesetechniques can be employed.

Alternatively, various portions of liner 14 and/or ring 16, such asthose on the liner near the axis of rotation 46, and/or locations on thelocking ring 16 surface which bear against the head of a femoral stem inarticulating relationship can, for instance, feature polyethylene orother materials which have been treated at desired levels to improvewear resistance. Treatment may be varied according to various locationsin liner 14, such as cross linking treatment being reduced graduallyacross the continuum that extends from the axis of rotation 46 to theliner interface surface 44. According to such wear resistance treatment,properties of various locations of liner 14 may feature improved,accentuated or optimized wear resistance, and other locations canfeature improved, accentuated, or optimized mechanical properties suchas yield strength, tensile strength, elongation and impact strength.

Liner 14 as shown in FIGS. 1-5 is adapted and configured to be received,preferably snugly, in non-articulating relationship with cavity 38 andshell 12. Liner 14 accordingly, in the embodiment shown in FIGS. 1-5,features an outer surface 42 with a first portion corresponding to thefirst portion of cavity 38 and a second portion generally correspondingto the second portion of cavity 38. An irregularity 75 such as a groove,slot, ridge or other desired structure can be formed in surface 42 inorder to cooperate with corresponding structure formed on or in shell 12to reduce or prevent rotation of liner 14 in shell 12.

Liner 14 includes a liner interface surface 44 which can, if desired, beshaped and finished to cooperate with locking ring 16 in order amongother things to optimize polyethylene wear and/or constrain relativemotion of liner 14 vis a vis locking ring 16 and/or shell 12.

Liner inner surface 30 is preferably hemispherical and finished asdesired in order to optimize articulating and wear properties of innerbearing 34 relative to stem head 20. Inner surface 30 may feature acenter of rotation which is different from the center of rotation ofouter surface 26 of the shell and/or the first portion of shell cavity38 or shell inner surface 40. Such geometry is sometimes referred to as“eccentric” and can be employed as desired and if desired in order toimprove migration and/or other properties of prosthesis 10.

Locking ring 16 features an outer surface 48 which is adapted tocorrespond to and fit within shell cavity 38. It may be finished andshaped as desired, and it may include a non-rotational irregularity suchas one or more irregularities 53 such as a tab, groove, slot, ridge orother structure which corresponds with one or more irregularities onshell inner surface 40 to reduce or prevent rotation of locking ring 16relative to shell 12 and thus reduce polyethylene wear.

Outer surface 48 of locking ring 16 may include a groove or otherstructure 50 about all or a portion of the periphery of outer surface 48for receiving retainer 18. A locking ring portal surface 52 togetherwith portal surface 36 of shell 12 form the portal 54 or opening ofprosthesis 10 through which head 20 and other portions of stem 24extend. Some or all of portal surface 52 can include a surface ofrotation or other modification 56 such as a chamfer or other non-curvedor curved surface of rotation or a surface shaped as otherwise desiredin order to improve clearance of stem 24 in portal 54 and thus increaserange of motion of stem 24 relative to prosthesis 10. In the embodimentshown, FIGS. 1, 2, 6, 7 and 8, the surface 56 is a chamfer.

Locking ring portal surface 52 may transition through surface 56 or asotherwise desired to a capture surface 58 which forms the surface withinprosthesis 10 of the least diameter about the center of rotation 46.Capture surface 58 of locking ring 16 may be, in cross-section,considered as cylindrical, rounded, or even a cusp. In any event,capture surface 58 of locking ring 16 which helps form the opening 54 inlocking ring 16 and the prosthesis 10 is preferably substantiallysmaller in diameter about axis of rotation 46 than the largest diameterof stem head 20 about that axis (in all relevant desired orientations).As a result, when stem head 20 is captured within prosthesis 10,portions of locking ring 16 and in any event capture surface 58, formthe mechanical structure which precludes or reduces dislocation of stem24 from prosthesis 10.

Locking ring 16 also preferably includes an inner bearing surface 32adapted to cooperate with head 20 in articulating relationship. Bearingsurface 32 may be formed as surface of rotation with curvaturecorresponding generally to that of the stem head 20, and it may besurfaced as desired for optimal wear and mechanical properties.

The inner bearing surface 32 and its relationship to stem head 20 isimportant, because locking ring 16 and in particular inner bearingsurface 32 absorb a substantial portion of tensile stress between stem24 and prosthesis 20 such as that which would cause dislocation. Innerbearing surface 32 of locking ring 16 thus needs to be shaped andsurfaced to reflect its reduced surface area which cooperates againststem head 20 in order to absorb the tensile load properly and optimallyand to transfer it through locking ring 16 and retainer 18 to andthrough shell 12, without unnecessary motion between locking ring 16 andshell 12.

Locking ring 16 is retained in and restrained in movement (at least in adirection parallel to axis of rotation 46) by retainer which fits withinlocking ring groove 50 and also a groove 62 formed in cavity 38 of shell12. Retainer 18 may be formed of spring or other memory retaining metaland preferably fits closely to the shape of grooves 50 and 62, no matterwhat shape they may assume, to stabilize, restrain, and cause capture oflocking ring 16 within shell 12 in an optimal fashion to, among otherthings, preclude pistoning of stem 24 and movement of liner 14. As shownin FIG. 2, an access 64 may be formed in shell portal surface 36 and/orliner portal surface 52 in order to access and manipulate retainer 18.In the preferred embodiment, retainer 18 may be a C-ring so that it canbe compressed, and locking ring 16 and therefore stem 24 can be removedfor disassembly or access.

FIG. 9 shows a prosthesis 10 having a unitary design, without a liner.Here, head 20 of stem 24 fits directly within cavity 38 of shell 12 toform inner bearing 34. In this structure, head 20 may be of ceramic ormetallic structure to cooperate with ceramic, metal, polyethylene shell12 or shell 12 formed of another material. Configuration and operationof locking ring 16 and retainer 18 may be similar to that shown inFIG. 1. Locking ring 16 may be formed of ceramic, metal, polyethylene orany other desired material. Dislocation of stem 24 from prosthesis 10 isprevented or reduced by the reduced size of opening 24 by virtue of thenon-split locking ring which is adapted to be assembled onto the neck 22of the stem before the head 20 is mounted on the stem.

b. Treatment or Formation of Prosthetic Components to Improve,Accentuate or Optimize Properties Such as Material Wear or Resistance toDislocation.

Treating or forming components or portions of them according to certainaspects of certain embodiments of the present invention in order toimprove, accentuate or optimize properties such as, for instance, wearperformance, and other components or portions of them in order toimprove, accentuate or optimize other properties, such as, for instance,mechanical properties, is relevant to prosthetic implants in general,but particularly to hip prosthetic components including total hipreplacement components, bipolar prosthetic components, unipolarcomponents, and versions of any of these which include a shell, acombination of a shell and liner, a combination of a shell, liner andlocking ring, or any other desired combination of components. Materialswhich can be the subject of such differential treatment or formationinclude not only polyethylene components, but also ceramic and metalcomponents. The bipolar structure disclosed and shown in the drawings istherefore only a subset of the aspects of the invention having to dowith such treatment or formation, and that disclosure and those drawingsshould not be interpreted or construed to read artificial structurallimitations, such as limitations to a bipolar prosthetic component, intothese aspects of the invention. However, it may be understood that thepreferred embodiment of the invention relates to bipolar implants havinga liner of polyethylene, part of all of which may be treated to improvebearing performance, e.g., by cross-linking.

As a first example of these aspects of the invention, consider anyprosthesis which includes a polyethylene component. It is generallyrecognized that treating polyethylene such as ultra high molecularweight polyethylene in order to cross-link it, such as by irradiationbefore, during or after forming the article into shape, significantlyand radically reduces polyethylene wear including polyethylene particlegeneration rates and volumetric wear rates. However, such treatment canalso substantially alter mechanical properties of the polyethylene asshown in the following Table 1 which are results obtained from testingaccording to ASTM Standards D638 (yield strength, tensile strength andelongation testing) and ASTM F648 (impact strength testing) which areincorporated herein by this reference.

Mechanical Properties Yield Tensile Impact Strength Strength ElongationStrength (Mpa) (Mpa) (%) (kJ/m²) Non-XL 22.2 48.2 390 96.1 5 Mrad 20.442.1 289 82.16 10 Mrad 21.0 37.1 237 69.4

According to this example, a total hip replacement acetabular componentof conventional structure such as that shown in U.S. Pat. No. 5,310,408entitled Acetabular Cup Body Prosthesis, Schryver et al. inventors,issued May 10, 1994, which is incorporated herein by this reference, canfeature a polyethylene liner which is formed of differentially treatedpolyethylene according to these aspects of the invention. Thus, portionsof the liner nearer the axis of rotation, and thus deeper within thecomponent and thus which can be expected to bear a greater load from thefemoral stem head, can be treated to improve, accentuate or optimizewear performance such as irradiation or other treatment to improve crosslinking or wear performance. Portions nearer the lip which have more todo with retaining the femoral stem head in the liner and thus inhibitingdislocation of the head can feature reduced or no such treatment inorder to improve, accentuate or optimize (here, retain) mechanicalproperties such as yield strength, tensile strength, elongationproperties, and impact strength. In other words, two different types ofpolyethylene may be used to form the liner. For example, standardpolyethylene may form one portion of the liner and cross-linkedpolyethylene may form another portion.

In other embodiments, more than two types of material may be used toform the liner. For example, the inner portion of the liner may beformed of ceramic (or any other suitable bearing material for jointarticulation) and the outer portion may be polyethylene (or any othersuitable bearing material for joint articulation), and some or all ofthe polyethylene material may be cross-linked. As a second example, in abipolar prosthesis that features a shell, a liner and a locking ring,such as the embodiment shown in FIG. 1, polyethylene that improves,accentuates or optimizes wear properties such as polyethylene that hasbeen irradiated or cross linked to a desired degree can be used in theliner 14 as opposed to the locking ring 16, which improves, accentuatesor optimizes mechanical properties having to do with, for example,inhibiting dislocation of a femoral stem head. Alternatively, the natureand treatment of the polyethylene or other material may be varied invarious portions of the liner 14, and various portions of the lockingring 16, and, for bipolar prostheses where no locking ring is used, inthe liner 14. The bipolar prostheses suitable for such differentialpolyethylene treatment or formation need not include a locking ring, andif they do, that locking ring can be split or configured as desired. Insuch prostheses without a locking ring, the liner 14 is adapted for thestem head to be forced into the liner before or after the liner isinserted or placed into the shell. If provided, the locking ring may beformed of any appropriate material, including but not limited topoly-ether-ether-ketone (PEEK), poly-ether-ketone-ketone (PEKK),cross-linked polyethylene (XLPE), or standard polyethylene.In alternative embodiments of bipolar prostheses according to thisexample which include liners and locking rings, various portions such asannular portions of the liner and locking ring may be treated as desiredto improve, accentuate or optimize wear resistance and mechanicalproperties for optimal performance relative to the loads expected andreceived at those locations. For instance, concentric portions of theliner in the vicinity of axis of rotation may receive higher wearresistance treatment and portions toward the lip or opening of the linermay feature treatment or varying degrees of it which optimize themechanical properties mentioned above in order, among other things, toreduce potential of femoral stem head dislocation. The treatment may becontinuous from one location to the next, or it may be discontinuous. Inbipolar structures in which no locking ring is employed, variousportions of the liner may be treated as desired to optimize wearresistance on the one hand and the mechanical properties mentioned aboveon the other hand. Again, the treatment may vary from one location tothe next in a continuous or discontinuous fashion or as otherwisedesired.

In a narrower example, the inventors have found it advantageous in thepreferred embodiment shown in FIG. 1 to form the locking ring 16 ofgenerally non cross-linked ultra high molecular weight polyethylenewhile the liner 14 is formed of ultra high molecular weight polyethylenestock that has been treated using irradiation techniques to improvecross-linking. The shell and/or the femoral stem head can feature asurface that includes oxidized zirconium (as can components in any ofthe total hip replacement, bipolar, unipolar or other prostheses withwhich differential material treatment or formation according to theseaspects of the invention are suitable.) Consequently, liner 14, which isgenerally absorbing the motion and wear from and imposed by head 20 ofstem 24, is formed of the polyethylene that features better wearresistance. This improved wear resistance is significant, for the loadimposed on liner 14 by head 20 can be three times body weight at a rateof one million or more cycles per year in the normal human. By contrast,the locking ring 16, which typically absorbs only loads caused bytendency of the stem 24 to withdraw through portal 54, can be made ofpolyethylene where wear resistance is perhaps less of an issue than theability of the locking ring 16 to retain head 20 in the prosthesis 10 byvirtue of higher yield strength, tensile strength, elongation, impactstrength, and other mechanical properties having to do with robustness,reduced deformation, and as otherwise desired.

Various changes, modifications, additions, and/or deletions can be madeto embodiments according to aspects of the present invention disclosedabove without departing from this scope or spirit of the invention.

What is claimed is:
 1. A hip prosthesis, comprising: a shell having anouter surface configured to engage acetabular tissue, the outer surfacetransitioning to a portal surface, and an inner surface forming a shellcavity; a liner disposed within the shell cavity; a non-split lockingring disposed within the shell, wherein in use a diameter of the lockingring is smaller than the largest diameter of a femoral head sized toarticulate with the liner; and wherein the locking ring comprises aportal surface, at least a portion of which portal surface of thelocking ring is coplanar with the portal surface of the shell; and aretainer for securing the locking ring and the shell, wherein theretainer is capturable in respective grooves formed in the shell and thelocking ring, and wherein an access formed in the shell portal surfaceprovides access to the retainer.
 2. The hip prosthesis of claim 1,wherein the groove formed in the shell extends circumferentially aboutthe inner surface of the shell.
 3. The hip prosthesis of claim 2,wherein the groove formed in the locking ring extends circumferentiallyabout the locking ring.
 4. The hip prosthesis of claim 3, wherein theretainer is a C-ring.
 5. The hip prosthesis of claim 1, furthercomprising an access formed in the locking ring portal surface thatprovides access to the retainer.
 6. The hip prosthesis of claim 1,wherein the locking ring portal surface comprises a chamfer adapted toprovide clearance for a femoral stem component in use.
 7. A hipprosthesis comprising: a shell which includes an outer surface adaptedto cooperate with acetabular tissue, the outer surface transitioning toa portal surface, and an inner surface forming a shell cavity; a lineradapted to fit within the shell cavity, the liner having an interfacesurface that does not extend to the portal surface of the shell; and aninner cavity having a diameter adapted to receive a femoral headcomponent in use; a non-split locking ring adapted to cooperate with theshell to retain the femoral head component within the shell, the lockingring having an outer surface retained by a portion of the shell cavity,an upper portion facing the interface surface of the liner, and a portalsurface opposite the upper portion, wherein at least a portion of theportal surface of the locking ring is coplanar with the portal surfaceof the shell; wherein the locking ring portal surface transitions to acapture surface on an inner portion of the locking ring that is smallerin diameter than the largest diameter of the femoral head component whenin use, the capture surface adapted to bear against the femoral headcomponent in articulating relationship in use in order to reducedislocation of the femoral head component and a femoral stem in use; anda retainer adapted to be captured in the shell cavity in order to retainthe locking ring in the shell, wherein an access formed in the shellportal surface provides access to the retainer.
 8. The hip prosthesisaccording to claim 7 further comprising a femoral head component.
 9. Thehip prosthesis according to claim 8, wherein at least one of the shelland the femoral head component comprises a surface of oxidizedzirconium.
 10. The hip prosthesis according to claim 7 wherein the lineris adapted to articulate relative to the shell.
 11. The hip prosthesisaccording to claim 7 wherein the liner is adapted to be locked into theshell.
 12. The hip prosthesis according to claim 7 in which the lockingring defines a continuous, non-split annulus which forms an opening toreceive the femoral stem, the opening having a diameter that issufficiently small to mechanically prevent passage of said femoral headcomponent through the locking ring.
 13. The hip prosthesis according toclaim 7, wherein the liner includes a first portion of treatedpolyethylene that provides improved polyethylene wear performance, andwherein the locking ring includes a portion of polyethylene that has notbeen treated, said portion of the locking ring having greater strengthproperties than said treated first portion of the liner.
 14. The hipprosthesis of claim 13, wherein the liner further includes a secondportion of polyethylene that remains untreated.
 15. The hip prosthesisaccording to claim 7, wherein the liner is variably treated, such thatat least one location on the inner cavity of the liner adapted tocooperate with the femoral head component is crosslinked to a greaterdegree than other locations of the liner.
 16. The hip prosthesisaccording to claim 7, where the liner is variably crosslinked and thelocking ring is not crosslinked.
 17. The hip prosthesis of claim 7,wherein the liner comprises a multi-material liner comprising a firstportion comprising polyethylene and a second portion comprising amaterial different than the first portion.
 18. The hip prosthesis ofclaim 17, wherein the first portion comprises crosslinked polyethyleneand the second portion comprises standard polyethylene.
 19. The hipprosthesis of claim 17, wherein the first portion comprises cross-linkedpolyethylene and the second portion comprises ceramic.
 20. The hipprosthesis according to claim 7, in which the shell cavity and thelocking ring each contain a groove, wherein the retainer is configuredto be captured in the grooves of the shell cavity and the locking ringin order to retain the locking ring in the shell.
 21. The hip prosthesisaccording to claim 7, in which the shell cavity and the locking ringeach include at least one irregularity, which irregularities are adaptedto cooperate in order to reduce relative motion of the locking ringrelative to the shell.
 22. The hip prosthesis according to claim 7, inwhich the shell cavity and the liner each include at least oneirregularity, which irregularities are adapted to cooperate in order toreduce relative motion of the liner relative to the shell.
 23. The hipprosthesis of claim 7, wherein the locking ring portal surface comprisesa chamfer adapted to provide clearance for the femoral stem in use. 24.The hip prosthesis of claim 7, wherein the non-split locking ring isresistant to deformation.
 25. The hip prosthesis of claim 7, furthercomprising an access formed in the locking ring portal surface thatprovides access to the retainer.